Provider First Line Business Practice Location Address:
3761 CENTRE ST
Provider Second Line Business Practice Location Address:
304
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-0919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-344-7036
Provider Business Practice Location Address Fax Number:
619-291-4426
Provider Enumeration Date:
05/01/2013